Media Statement: Law Reforms Necessary to Curb Vulnerabilities in Systems for Fraudulent Medico-Legal Claims

A joint meeting of the Portfolio Committee on Health, the Standing Committee on Appropriations and the Standing Committee on Public Accounts (SCOPA) says law reforms are necessary to close gaps in legislation that expose government systems to fraudulent medico-legal claims.

The pre-audited financial statements for provinces reveal that the nine provincial health departments have paid R1.5 billion in the 2023/24 financial year for medico-legal claims, with contingent liabilities sitting at R63.5 billion. The committees were informed that doctors that are mostly targeted by fraudulent lawyers are obstetricians, gynaecologists, neurosurgeons as well as spinal and orthopedic surgeons. This leads to these specialists paying huge amounts in medical indemnity insurance to protect themselves.

The committees received a briefing from Health Minister Dr. Aaron Motsoaledi on the interventions the Department of Health is undertaking to deal with the collusion between medical professionals and lawyers that defraud the system. The committees were also briefed by the Auditor-General (AG) on the three-year audit. The audit shows that poor record-keeping by hospitals and clinics contributes to the challenges associated with medico-legal claims.

Currently, valid and fraudulent medico-legal cases that end up on the court roll are kept in the system for a prolonged period, negatively impacting the victims. The Minister wants to set up a model that will allow a panel of experts comprising of retired judges, retired senior medical and nursing staff, lawyers, social workers and other relevant professionals to assess all the medico-legal claims to determine and arrive at a fair compensation for those who have experienced medical injuries. This assessment will prevent the backlog of medico-legal cases that end up in court.

This is a system that is currently implemented in other parts of the world including Scandinavian countries. Legislative reform is necessary for this model to be successful, and the joint committees supported the proposal for the introduction of such legislation.

The committees have noted the consequence management measures undertaken by the department by referring all the implicated medical professionals, legal practitioners and healthcare workers to the National Prosecuting Authority and Lawyers Practice Council for criminal prosecution and professional misconduct. In addition, the department has reported all the implicated healthcare workers to various statutory bodies. While acts of fraudulent claims are in practice, it is equally important that health standards are maintained to ensure safe measures for health practitioners.

Distributed by APO Group on behalf of Republic of South Africa: The Parliament.